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Much of the concern for young athletes at risk for concussion goes to the obvious heavy-hitters: football, soccer, basketball. But an expert who studies the injury in youth sports say one major activity is being overlooked: cheerleading.

"Cheer is one of the sports that seems to not have afforded the amount of attention it deserves," said Tony L. Strickland, a neurology professor at the University of California, Los Angeles, and head of the Sports Concussion Institute, where he sees dozens of cheerleaders who've sustained concussions each year.

Concussions have been getting more attention lately, in part because young athletes are getting bigger, stronger and faster. But as the blows to their heads are getting more powerful, young athletes keep shaking them off.

Strickland says cheerleaders are especially likely to suffer a concussion silently, because of the unique position that cheer puts them in — they're battling for the respectability of their sport. "They don't want to be viewed as a liability," Strickland said.

Lobosco, of Greenwich, Conn., is 18 now, but was 16 at the time of her fourth concussion, cheering at an All-Star competition. She was a base — the grounded cheerleaders responsible for tossing and catching their team's flyers. At this competition, Lobosco was working with a younger, inexperienced flyer who'd been brought in at the last minute to cover for an injured girl. During their routine, the newbie came crashing down on top of Lobosco, sending both girls to the ground.

“I just got up and I was like, ‘Yeah, I’m fine, I’m fine,’ but I could tell I’d had a concussion, 'cause I’d had three before,” Lobosco said. She kept quiet about it until the next day, when her mother noticed Jessica was acting oddly and took her to the hospital.

“She’s always very nice, and doesn’t talk back, but she was snapping at me,” Claudia Lobosco said. “She couldn’t look at light, her head was pounding, she was exhausted and she wasn’t really making much sense.”

Girls at extra risk
Female athletes may be at even higher risk for suffering a concussion than their male counterparts, Strickland said. Girls' neck muscles are generally weaker than boys', making them more susceptible to dangers that come from rapid acceleration or deceleration, and whiplash. And boys are more likely to knock each other around as they practice, so their bodies may be more prepared to deal with big blows come gametime.

"The frequency that female athletes sustain subconcussive events — the blow before the larger blow — are lower," Strickland said. "It's sort of like anything else — you acclimate. It's not acclimating to getting your bell rung; it's acclimating to absorbing the energy of the force of another player, or of the ground."

That puts cheerleaders at particular risk. Most head injuries in cheerleading come from a kick from a teammate, or a hard fall — and cheerleaders aren't exactly kicking each other or throwing each other to the ground as they practice.

Athletes and coaches need to learn to recognize the signs of concussion: nausea, problems with balance, dizziness, headaches, sensitivity to light or sound, problems with attention or concentration, extreme fatigue or personality changes such as increased irritability. It’s tempting for young athletes like Lobosco to keep practicing or competing right after they’ve sustained a concussion, but that can lead to a second concussion — and long-term effects such as prolonged changes in personality or mood, anxiety, depression, even cognitive and memory problems.

This year, a new rule requires high school athletes who exhibit concussion symptoms to be immediately removed from the action, and they can’t return until permitted by a health professional. But this requirement, set by the National Federation of State High School Associations, is voluntary for most cheer squads.

Since her fourth concussion two years ago, Lobosco has suffered severe memory problems. She's had to readjust the way she lives her life to keep those problems in check as she navigates her freshman year at Southern Connecticut State University. She used to write every little to-do item and homework assignment down in her planner; now, if she does, those assignments won't get done, because she'll forget to check the planner. So she writes endless lists on her wrists, forearms — all the way up to her elbows, on the busiest days.

"To be honest, I don't really like watching cheer that much anymore,” Lobosco says. “I get nervous because I know that I've been hurt before, and I just feel like — I don't know if they should tone it down a bit, but they should at least really practice and get better training and make sure that everybody knows what they're doing."